An abdominal aortic aneurysm occurs when the part of the aorta travelling down into the abdomen balloons out more than 50%. If caught early, treatments can be used to prevent rupture of the aneurysm. However, many of these aneurysms are asymptomatic and go undetected until they rupture, causing large amounts of blood to spill into the abdominal cavity and typically leads to death, if left untreated. The current mortality rate is between 50 and 90%. The resources required to treat patients with ruptured aortic aneurysms is quite substantial given that they need blood transfusions and can have prolonged hospital stays. Patients either undergo a more invasive operative repair, associated with greater blood products transfusions and complications, or if relatively stable, undergo a less invasive repair with tubes called stents. There is less morbidity associated with the latter, endovascular repair. To prevent blood loss in elective surgeries, drugs that promote blood clotting are often used. One drug, tranexamic acid , has been shown to reduce blood loss, reduce the number of blood transfusions required and improve patient outcomes in elective cardiac and orthopaedic surgeries, and more recently, in patients with traumatic hemorrhage. However, this drug has not been tested in this particular population. The purpose of this pilot project is to evaluate the effectiveness of tranexamic acid in reducing clinically significant bleeding in patients with ruptured aortic aneurysms in hospital sites across Saskatchewan using a single-group intervention design. The investigators will compare the data from patients treated with tranexamic acid to retrospective data from a control group that is matched on key variables. The investigators predict that tranexamic acid will result in reduced bleeding, reduced need for blood transfusions, less patients that require open surgery and improved patient outcomes. The results of this study will help determine if this treatment is effective at preventing the death of many people with ruptured abdominal aortic aneurysms.

Clinically significant bleeding [ Time Frame: Participants will be followed for average length of stay, which is approximately two weeks ] [ Designated as safety issue: No ]

Hemoglobin less than 100 g/L or 2 or more units of red blood cells or 2 or more units of fresh frozen plasma (FFP), or 5 or more units of cryoprecipitate, or more than 1 unit of platelets, or activation of the health region's Massive Transfusion Protocol.

Secondary Outcome Measures:

Number of ruptured abdominal aortic aneurysms requiring open laparotomy compared to endovascular stunting [ Time Frame: Patients will be followed during hospital length of stay, which is an average of two weeks ] [ Designated as safety issue: No ]

We will compare the number of ruptured aortic aneurysms that require open repair with laparotomy versus those that can proceed with endovascular stenting.

Number of blood transfusions [ Time Frame: Patients will be followed during hospital length of stay, an average of two weeks ] [ Designated as safety issue: No ]

We will examine the number of blood transfusions, including individual products

Incidence of Transfusion Related Acute Lung Injury (TRALI) [ Time Frame: Patients will be followed during hospital length of stay, which is an average of two weeks ] [ Designated as safety issue: No ]

Incidence of Transfusion Related Reactions [ Time Frame: Patients will be followed during hospital length of stay, which is an average of two weeks ] [ Designated as safety issue: No ]

This will examine the incidence of transfusion related reaction in patients with ruptured aneurysms

Mechanical ventilator days [ Time Frame: Patients will be followed during hospital length of stay, an average of two weeks ] [ Designated as safety issue: No ]

The number of days required by the patient on a ventilator will also be examined.

Length of stay in ICU [ Time Frame: Patients will be followed during hospital length of stay, an average of two weeks ] [ Designated as safety issue: No ]

Determination of length of stay in ICU

Length of stay in hospital [ Time Frame: Patients will be followed during hospital length of stay, an average of two weeks ] [ Designated as safety issue: No ]

Incidence of intrabdominal hypertension [ Time Frame: Patients will be followed during hospital length of stay, an average of two weeks ] [ Designated as safety issue: No ]

Incidence of intrabdominal hypertension may be related to blood products and resuscitation requirements.

Incidence of Abdominal Compartment Syndrome (ACS) [ Time Frame: Patients will be followed during hospital length of stay, an average of two weeks ] [ Designated as safety issue: No ]

We will examine the incidence of abdominal compartment syndrome (ACS)

Requirement of either continuous or intermittent renal replacement therapy (dialysis) [ Time Frame: Patients will be followed during hospital length of stay, an average of two weeks ] [ Designated as safety issue: No ]

If patients are hypotensive (low blood pressure), they will require vasoactive or inotropes for maintenance of blood pressure. These patients would not tolerate conventional intermittent hemodialysis. Instead, in this group, Continuous Renal Replacement Therapy would be the option. If the patient has normal blood pressure, and is not on vasoactive drugs, then intermittent renal replacement therapy would be acceptable.

Cardiac morbidity [ Time Frame: Patients will be followed during hospital length of stay, an average of two weeks ] [ Designated as safety issue: No ]

Cardiac morbidity such as cardiac arrest, myocardial infarction, stroke or seizure will be examined

Multiorgan Dysfunction Score [ Time Frame: Patients will be followed during hospital length of stay, an average of two weeks ] [ Designated as safety issue: No ]

All cause 28 day mortality [ Time Frame: 28 days post-surgery ] [ Designated as safety issue: No ]

We will be administering Tranexamic Acid in patients with ruptured abdominal aortic aneurysms to determine if this has an effect on primary outcome measures as significant bleeding, blood transfusion requirements.

Drug: Tranexamic Acid

two doses of Tranexamic Acid will be given to patients with rupture abdominal aortic aneurysms

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Please refer to this study by its ClinicalTrials.gov identifier: NCT02125890